Information Collection

Work Plan Tool - Initial Population

IC 221587 under ICR 201605-0920-009 · OMB 0920-1130.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1130 can be found here:

Documents and Forms

Document Name Document Type
Work Plan Tool - Initial Population Form
Rape Prevention and Education Work Plan Tool Att._3b_Work_Plan_Tool_Screenshots_041416.pdf Form
Att._3a_Work_Plan_Tool_041416.docx Rape Prevention and Education Work Plan Tool - Word IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Work Plan Tool - Initial Population	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Rape Prevention and Education Work Plan Tool	Att._3b_Work_Plan_Tool_Screenshots_041416.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18	18
Annual IC Time Burden (Hours)	180	180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Rape Prevention and Education Work Plan Tool - Word	Att._3a_Work_Plan_Tool_041416.docx	05/19/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.